Schindler O S, Misra R, Spalding T J W
British Arthritis and Sports Injury Clinic, Droitwich-Spa, Worcestershire, United Kingdom.
J Orthop Surg (Hong Kong). 2006 Dec;14(3):325-9. doi: 10.1177/230949900601400318.
Medial tibial plateau osteonecrosis is a disease that lacks distinguishing signs and symptoms, especially in the early stage, and requires clinicians to exercise a high degree of suspicion to prevent disease progression. We present a case of spontaneous osteonecrosis of the medial tibial plateau in a 59-year-old woman. Within 5 months of the onset of symptoms, the entire medial tibial plateau collapsed down into the metaphyseal region, causing severe varus deformity, instability, and inability to walk without crutches and a hinged knee brace. Initial symptoms of medial joint line pain and generalised swelling of the knee were attributed to early degenerative changes. Subsequent radiographs were misinterpreted as simple medial compartment arthritis. Due to severe bone loss and significant lateral collateral ligament attenuation, a total joint arthroplasty was required, using a stemmed tibial component with medial metal block and bone graft augmentation. The speed of bone collapse and the extension into the metaphysis, requiring complex joint arthroplasty, makes this case unique.
胫骨内侧平台骨坏死是一种缺乏明显体征和症状的疾病，尤其是在早期阶段，这就要求临床医生高度怀疑，以防止疾病进展。我们报告一例59岁女性自发性胫骨内侧平台骨坏死的病例。在症状出现后的5个月内，整个胫骨内侧平台塌陷至干骺端区域，导致严重的内翻畸形、不稳定，且不借助拐杖和铰链式膝关节支具就无法行走。最初的膝关节内侧关节线疼痛和膝关节普遍肿胀症状被归因于早期退行性改变。随后的X线片被误诊为单纯的内侧间室关节炎。由于严重的骨质流失和明显的外侧副韧带松弛，需要进行全关节置换术，使用带柄的胫骨假体并加用内侧金属块和植骨增强。骨塌陷的速度以及延伸至干骺端，需要进行复杂的关节置换术，使得该病例具有独特性。
